KANO, Nigeria -- Children with lifeless legs roll themselves up to intersections on wooden dollies, begging motorists for spare change. A workshop makes and sells dozens of colorful tricycles with hand cranks instead of foot pedals.
But even in a place where the ravages of polio are so visible, parents such as Binta Sani, 18, have repeatedly refused to allow their children to be protected against the disease.
A teenage girl in Kano gives polio vaccine to Hasfat Sani, 2. Holding Hasfat is Jamilu Garba, who persuaded the child's mother to agree.
(Photos Craig Timberg -- The Washington Post)
Twice health workers came to her home, asking to place drops of polio vaccine on the tongue of her 2-year-old daughter, Hasfat. Twice Sani refused, saying she had heard that the vaccine causes sterility. On their third try last week, she finally relented, but only after a man she knew and trusted persuaded her that no harm would come to Hasfat.
"My neighbor convinced me that it was safe," Sani said, waiting inside her house while the man carried the screaming child out to receive the drops. "He has lived here for years. He would never do anything to hurt my child."
Household by household, Nigerian health officials are making slow but steady headway against the misinformation and mistrust that for two years have sabotaged efforts to eradicate polio here. The crippling disease, wiped out years ago in much of the world, is spreading swiftly through Africa, and this ancient Muslim city in northern Nigeria is at the epicenter of the epidemic.
Over the past several months, a barrage of radio and television messages from doctors, clerics and politicians has begun to overcome popular rumors -- fueled in part by rising anti-Americanism -- that the imported vaccine contains anti-fertility drugs or the virus that causes AIDS.
As a result, officials said, the number of children being vaccinated is rising, and the number of rejections by fearful parents is dwindling. In July, a first round of immunizations reached 56 percent of the children younger than 5 in Kano. In September, a second round reached 65 percent. Last month, a third round reached 81 percent -- close to the level needed to prevent the disease from taking root in a community. Each child needs three or four doses of vaccine to be fully protected.
With the rate of vaccinations rising so swiftly, global health officials are now predicting that polio will be eradicated by 2005 or 2006.
"We need only one or two years, and we'll finish it," said Abdulwahab Al-Anesi, a Yemeni physician from the World Health Organization who recently took over the vaccination program here.
Not long ago, public hostility in this bustling but traditional city had brought the anti-polio campaign to a virtual halt. On the streets, children hurled stones at teams of high school girls hired to deliver the vaccine and chanted, "Don't take it! It's not a remedy. It's a disease."
The job, for which the students are paid $3 a day, amounted to hazardous duty. "There were so many stones thrown at us, and the kids were booing," recalled Mariya Nafi'u, 17. She rolled up her right sleeve to show a scar where a rock had gashed her. "Some of us didn't have the courage to go out."
Kano, a dusty metropolis with a distinct Arab flavor, is fertile ground for the spread of polio. The virus is spread via feces, especially in dense, dirty residential areas, and it can lead to paralysis and even death. Vaccines eliminated the disease from the developed world in the 1970s, but in 1988 there were still 350,000 cases in 125 poorer countries.
A massive international campaign ensued, and by 2003, the virus remained endemic in just six countries: Nigeria, Niger, Egypt, India, Pakistan and Afghanistan. Efforts were getting underway to immunize children across Nigeria when politics suddenly intervened.
The U.S. invasion of Iraq exacerbated hostility toward the United States among Muslims in the region, where women cover all but their faces in public, T-shirts of Osama bin Laden are popular and the dominant source of news is al-Jazeera, the Arab satellite television network. Religious leaders and even doctors began questioning the safety of the U.S.-promoted vaccine.